Mar 29, 2013 | Uncategorized
Health care providers are REQUIRED to complete Compliance Certification! The Centers for Medicare & Medicaid Services (CMS) requires that all Humana business partners, including health care providers, complete required compliance training and certifications.
nHealth care providers can complete this information online via Humana’s secure Compliance website, which requires internet access. To access the website, health care providers must be registered on Humana.com or Availity.com. Detailed instructions and additional information on completing these requirements, including registration, are available here. While health care providers are encouraged to complete the compliance requirements within 30 days of notification, these requirements must be completed no later than December 31, 2013.nnSource: www.humana.com; February 2, 2013.n
Healthcare and Reimbursement Updates
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Mar 29, 2013 | Uncategorized
In what appears to be a shift in policy, the Centers for Medicare & Medicaid Services has begun auditing providers attesting to Meaningful Use of their electronic health record systems before doling out incentive payments, according to a report from the American Academy of Family Physicians (AAFP).
nCMS has targeted 5 to 10 percent of those who attested to Meaningful Use in January 2013, according to Elizabeth Holland, director of the Health IT Initiative Group’s Office of E-Health Standards and Services. Eligible professionals selected for audit were chosen both “randomly” and “based on protocols that identify suspicious or anomalous attestation data,” according to the AAFP News Now article.nnAn additional 5 to 10 percent of physicians and others will be subject to post-payment audits, according to Holland. The audits are being conducted by Garden City, NY-based CPA firm Figliozzi and Company.nnCMS is required to conduct audits of providers attesting under the EHR incentive program, and began postpayment audits in July 2012. However, the U.S. Department of Health & Human Services’ Office of Inspector General (OIG) chastised CMS in November 2012 for poor auditing of the incentive program, a concern echoed by the Government Accountability Office.nnOIG specifically recommended that CMS conduct prepayment audits of a select number of providers before issuing their incentive payments. At that time, CMS would not concur with the OIG’s recommendation, saying that prepayment audits would impose a “huge new burden” on providers and impede EHR adoption.nnOther CMS programs are moving from “pay and chase” to prepayment review. GAO recently reported that expanding prepayment audits could save Medicare $115 million.nnTo learn more, here’s the AAFP New Now articlennSource: www.fierceemr.com; Marla Durben Hirsch; March 24, 2013.n
Healthcare and Reimbursement Updates
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Mar 29, 2013 | Uncategorized
Be on the lookout! Humana staff members regularly conduct medical record audits in randomly selected physician offices to help satisfy regulatory compliance by evaluating physician compliance with adopted medical record documentation guidelines. The minimum passing score is 85 percent compliance with the guidelines, with a goal of 90 percent. These guidelines are available for downloading and printing at Humana.com; click on the PDF entitled “Medical Records Guidelines” under the list of Clinical Practice Guidelines.nnSource: www.humana.com; February 2, 2013.n
Healthcare and Reimbursement Updates
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Mar 21, 2013 | Uncategorized
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Reimbursement Issues (denials, late payments, incorrect payments, inaccurate information)n
- Expanded insurance coverage provisions through the Affordable Care Act (ACA)
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- Data collection for meaningful use and reimbursement incentives
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- Expanded credentialing requirements create a new and more complex environment for providers and healthcare facilities
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Reimbursement models are changing and Payer Relationship Management (PRM) is more important than ever!
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- A strategic approach to understanding and cultivating payer relationships is the key to success. They need you and you need them!
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- Understanding your own data will assist in cultivating financially positive relationships – knowledge is power!
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Take control of your Payer Relationships!
nPRM supports your providers, practices and facilities to capture, store, monitor, track and leverage all information related to the billing and reimbursement processes. This information includes detailed and up-to-date provider profiles (credentialing), practice profiles (leverage), payer profiles (market research), reimbursement activities (proper payments), and patient care activities and efforts (data collection).n
PRM is the lifeline of your practice and facility—
n—and requires expertise, knowledge, and a multidisciplinary approach of professionals who understand and stay ahead of the changing healthcare environment and requirements. Every practice and facility should focus on PRM to maximize revenue by:n
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- Incorporating tools and systems to report and understand your practice’s financial health, financial needs, and patient care data
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- Understanding the current relationship with reimbursement sources (i.e. payers), including language, rates, etc.
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- Understanding your market, your competition, and most importantly your value!
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- Identifying opportunities to increase reimbursement (leverage)
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- Verifying all provider and contract information is loaded correctly in payer systems to ensure proper and timely payments (credentialing)
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- Understanding new reimbursement models to obtain additional payments (i.e. incentive payments), and avoid penalties that will decrease revenue
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- Ensuring efficient reimbursement processes to maximize cash flow (i.e. EFT, ERA)
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nNeed Assistance with your PRM? Click here…
Mar 21, 2013 | Uncategorized
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While there’s no code for Spring Fever, many people can’t wait for:
nY93.52 – Activity, horseback ridingnY93.83 – Activity, roughhousing and horseplaynY93.66 – Activity, soccernY93.53 – Activity, golfnY93.01 – Activity, walking, marching and hikingnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2014 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
Mar 15, 2013 | Uncategorized
T65.6X1A – Poisoning from green dye in beer, initial encounternR53.83 – Fatigue due to exhaustively searching for 4-leaf clovernY00.xxxA – Assault by blunt object (pot o’gold) thrown by leprechaun at the end of the rainbow, initial encounternW22.02xA – Injury incurred by walking into lamppost during St. Patty’s Day Parade, initial encounter.nnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2014 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
